Wednesday, October 14, 2009

Eggs, Flu, Young

Eggsactly thirty years ago, my daughter, Brooke, was diagnosed with food allergies – egg being one of the foods producing dramatic hives and wheezing. Getting the diagnosis wasn’t easy. Oh, the symptoms were quite evident but in those times, food allergies were more or less considered a disease of neurotic moms and there just wasn’t much direction or advice in the medical literature.

So each flu season, I faced a quandary. Flu shots contain trace amounts of egg protein. Should I waltz my daughter to the doctor for a shot that could make her sick -- or risk the ravages of the flu that could mean months of lingering asthma symptoms? The more questions I asked, the more controversy I found… that is, until we consulted with an allergist who, after testing Brooke, said it would be possible to give her the shot in gradual doses over the period of an hour or so. Eureka!

Fast forward thirty years, and parents of children with asthma and egg allergy face the same question, this time with an H1N1 twist. The good news is that H1N1 flu vaccine is prepared in the same manner as the seasonal flu vaccine.

Here’s a primer of sorts if your child has confirmed or suspected egg allergies and has asthma. You can also find more information from the American College of Allergy, Asthma & Immunology (ACAAI)

1) Consult with an allergist.

2) Tell the allergist about symptoms that your child experienced when eating or touching eggs – raw (found in lemon meringue pie, for example), cooked, in baked goods, etc.

3) Mention any history of life-threatening egg allergy symptoms such as difficulty breathing, throat swelling, wheezing or fainting. These usually indicate the need for additional testing before administering the H1N1 vaccine.

4) The allergist will use skin prick testing: a small droplet of egg protein and another droplet of the H1N1 vaccine are placed on the skin. A tiny prick is made underneath each droplet.

Negative test results indicate that no allergic reaction occurred during the first phase of testing. In the second phase, the allergist will inject a small droplet of the diluted vaccine into the skin.

If your child still shows no signs, symptoms or skin reaction, your child can get the full dose of H1N1 vaccine but then must wait a full 30 minutes at the allergist’s office before leaving. That way, if your child shows symptoms such as hives, flushing or shortness of breath, the allergist and nursing staff are prepared to recognize and treat it.

A word of caution: A negative skin test to egg-based H1N1 vaccine does not mean you or your child no longer has egg allergies! So don’t go home and think you can serve up scrambled eggs or stop reading food labels!

OK, so what happens if the test result was positive, i.e. show that your child is allergic to the vaccine?

“If the test result is positive and the person is at high risk of complications from the flu because of pre-exising respiratory or heart disease, the vaccine still may be given using desensitization procedure,” said Sami Bahna, MD, PhD, president-elect of the American College of Allergy, Asthma and Immunology (ACAAI), and professor of pediatrics and Medicine and Chief of Allergy and Immunology at Louisiana State University Health Sciences Center in Shreveport. “This is compatible with the 2009 Policy of the American Academy of Pediatrics.”

The vaccine would be administered under the skin in gradually increasing doses at 15 to 20 minutes until the total dose is given. Dr. Bahna cautions that the procedure should be done by an experienced physician in a medical facility where measures are readily available for treating any potential reaction. The allergist is well trained and qualified for that.

A final note: FluMist vaccine is not approved for use in kids or adults with asthma, or for those with members of the immediate family who have asthma. The antiviral Relenza is known to provoke coughing and wheezing in patients with asthma. Tamiflu is a reasonable alternative but it must be used in the early stages of the flu.

And the last word: ACAAI states that even though most cases of H1N1 are mild, many of the children who have died were ones who had asthma. The Centers for Disease Control and Prevention (CDC) just released updated data showing that the most prevalent underlying illness among patients hospitalized with H1N1 was asthma (26 percent of all adults hospitalized with H1N1 had asthma). In most cases, it appears that symptoms begin to improve and then the child’s symptoms rapidly decline. Contact your allergist now to discuss specific actions to take should your child or someone in your family develop seasonal flu or H1N1 symptoms. By all means, get both flu vaccines in a medical-care setting where reactions, if they occur, can be monitored.

Kids and adults with asthma are at high risk of complications and death from seasonal or H1N1 flu. You can find more information on AANMA's website.

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